HIV, BREAST-FEEDING AND UNDER-5 MORTALITY - MODELING THE IMPACT OF POLICY DECISIONS FOR OR AGAINST BREAST-FEEDING

A computer model was developed to assess the impact on under-5 child m ortality of breast-feeding practices in developing countries in the co ntext of HIV infection. The model was used to estimate the effect on m ortality of cessation of breast-feeding among mothers HIV-positive and mothers HIV-negative at birth, for both urban and rural settings. Usi ng parameter values for a hypothetical East African country, cessation of breast-feeding in urban areas was predicted to result in increases in under-5 mortality of 108% for children of mothers HIV-negative at birth, and 27% for those HIV-positive at birth, with slightly larger i ncreases in rural areas, suggesting that breast-feeding should continu e to be promoted. A sensitivity analysis was conducted to identify cri tical values of key variables for which a review of policies encouragi ng breast-feeding is indicated. This showed that, even under extreme a ssumptions, cessation of breast-feeding among mothers HIV-negative at birth (but at risk of acquiring HIV during the lactation period) would increase under-5 mortality. For mothers HIV-positive at birth, the ke y variables are the additional risk of vertical transmission attributa ble to breast-feeding, the under-5 mortality rate (U5MR) in breast-fed children, and the relative risk of mortality in non-breast-fed compar ed to breast-fed children. Depending on the values of these key variab les, there may be some urban populations with low U5MR in which the po sitive and negative effects on under-5 mortality of a policy change ar e finely balanced. However, no change in policy should be made in thes e areas until more precise information is available on the key variabl es, and the many adverse consequences of such a change have been fully explored.